Making Sense of a Second Opinion

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In general, you can expect a second opinion to do one of three things:

Confirm the first opinion. This can be very reassuring and increase your confidence in your original diagnosis and/or treatment plan.

Provide more information about the breast cancer or additional treatment options without overturning the first opinion. This too can be reassuring while also opening up some other options you may not have considered (different treatment approaches, for example).

Differ from the first opinion in important ways, or even completely contradict it. Initially, this can be quite worrisome. But a different opinion from another expert is an opportunity to make sure you have the right diagnosis and an appropriate treatment plan. For example, the second pathology report could contain results suggesting the cancer is much more aggressive or less aggressive than the first pathologist thought. This information would affect treatment decisions. Even if the pathology report remains the same, a second doctor might recommend more treatment, less treatment, or different approaches to treatment than the first doctor.

If you’re faced with a second opinion that differs from the first, you may find the following tips helpful:

  • Make an appointment with your first doctor to discuss the second opinion, ideally after he or she has spoken with the other doctor. Your doctor may be able to explain the difference of opinion or may even come to agree with the second opinion.
  • Ask both doctors to explain how they arrived at their conclusions. Ask them to talk about how they interpreted your test results, what research studies or professional guidelines they are using to make treatment recommendations, and how they have advised other patients in your situation.
  • If possible, ask the two doctors to consult with each other to see if they can reach consensus.
  • Seek out yet another specialist — whether a pathologist, surgeon, medical oncologist, or radiation oncologist — to weigh in on the two opinions and give his or her take on the situation.
  • If there is variation in the recommended treatment plans, do your own research on the latest breast cancer treatment guidelines and then discuss your findings with your original doctor. Two good sources are the National Comprehensive Cancer Network (NCCN) Treatment Guidelines and the National Cancer Institute’s (NCI) PDQ® Cancer Treatment Summaries. Both are available in versions for health professionals (which use medical language and terminology) and patients (which use everyday language).
  • Discuss your situation with other women you know who have had breast cancer, or with others in an online forum or support group, such as the discussion boards here at Breastcancer.org. Or try calling a cancer information hotline such as SHARE Cancer Support (1-866-891-2392) or those available through the National Cancer Institute (1-800-4-CANCER) or the American Cancer Society (1-800-ACS-2345).

As you weigh the information, try to remain objective. It can be very tempting to assume that the “nicer” or “friendlier” doctor is right, or to believe the one who gives you better news. You may reach a point where you and your family have to make the final decision about the course of action that’s right for you. If there is a true difference of opinion that two or even three breast cancer specialists cannot resolve, then you’re not likely to resolve it either.

If the second opinion doctor is in your area and you decide you want to switch over your care, ask him or her about this option. Many doctors will be happy to do so. Others may have a policy against this, either because they see it as a conflict of interest or it goes against an agreement they have with insurers or other third-party payers. If you’re happy with your current doctor and treatment team, but you want to follow the recommendations of the second opinion doctor, this may be an option, too. Talk to your current doctor about this.

Whatever you decide, you can rest assured that you’ve made the most informed decision possible by getting a second opinion.

Personal Quote

“I had one doctor telling me to take measures that were pretty drastic, and another doctor saying that it just wasn’t necessary to go that far. It all boiled down to a quality-of-life issue. Quality of life won out. Not everyone would have made that decision. Sometimes these situations challenge your courage, but they can also get you very focused on what works for you. You’re asking yourself, ‘Okay, within these parameters, how would I really like my life to be?’”

— Claire Nixon, senior editor, Breastcancer.org

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